Reading of the Week: To Screen or Not to Screen – Pregnancy & Depression Screening

From the Editor

“Panel Calls for Depression Screenings During and After Pregnancy”

A government health-care panel making a revision to a past recommendation seems pretty ‘inside baseball’ – and hardly the stuff of international headlines. Last week, though, the decision of the U.S. Preventive Services Task Force to now recommend the screening of pregnant and post-partum women for depression was reported from New York to New Delhi.

For the record, The New York Times story (whose headline appears above) ran on the front page.

Why the change and what are the implications?

To screen or not to screen…

This week’s Reading looks at the big decision and we consider: is it a big bust?

DG Continue reading

Reading of the Week: Freud Is Dead – Are His Ideas Dead, Too?

From the Editor

Sigmund Freud is dead.

Are his ideas dead, too?

Sigmund Freud – Irrelevant?

Psychiatry has left much of Freudian analysis behind. Is that a good thing? This week’s Reading ponders this question – first, with an excellent essay by The Guardian’s Oliver Burkeman that considers “the revenge of Freud,” then with a response from New York Magazine’s Jesse Singal, and, finally, with a recent paper from The American Journal of Psychiatry comparing patients with bulimia who received psychoanalysis and who received CBT.

DG Continue reading

Reading of the Week: The Suicidal Doctor

From the Editor

In December, the Readings included the Meta et al. paper from JAMA considering depression and residents. The review – which included more than 50 papers – found that the prevalence of depression or depressive symptoms among resident physicians was 28.8%.

Dr. David Goldbloom’s comment on the paper is worth repeating: “it is a sobering reminder that the white coat is not Kevlar against the illnesses we treat, and our professional culture still has a long way to go in recognizing, accepting and supporting that we get sick, too.”

This week we look again at physicians and mental health. The first selection is an essay by a doctor in which he discusses his suicidal thoughts. Then, with an eye on practical interventions to help doctors at risk, we consider the JAMA Psychiatry study on CBT for interns (with a modern twist).

DG Continue reading

Reading of the Week: Values and Schizophrenia, and More

From the Editor

Welcome to first Reading of the Week of 2016.

Continuing the format started in December, I’ve made several selections here. This week: the obituary of an influential psychiatrist, a clever paper on values and schizophrenia, and a report that considers the use of psychiatric services in Ontario.

In general, Readings in this format don’t have a common theme. That said, this week, a common thread runs through the three selections: challenging assumptions.

Dr. Agid and his co-authors look at the values of those with schizophrenia, challenging the assumption that our patients value what we value; the HQO-ICES report challenges what we think we know about psychiatric care and care delivery in Canada’s largest province. And what can be said of Dr. Robert Spitzer? Well, he made a career out of challenging psychiatric assumptions – much to his credit, and to our benefit.

DG Continue reading

Reading of the Week: The Best of 2015 — Books, Papers, and Hope

From the Editor

This will be the last Reading of the Week for 2015. (The Readings will resume in a fortnight.)

A bit of housekeeping: the Reading of the Week is a labour of love. There is no industry support for this project – or, in fact, any funding. Still, it’s hardly my project. Many readers (particularly residents) suggested papers and made comments over this past year. I’m also deeply grateful for the support of several colleagues; Drs. David Goldbloom and Mark Fefergrad deserve particular mention. And my father and wife have been great editorial supports.

It’s a Reading of the Week tradition to close the year by highlighting the best of the past 12 months.

Looking over the Readings of this year, I’m struck by the diversity of the publications that I could draw selections from. Sure, the Readings of 2015 included papers from The New England Journal of Medicine and JAMA Psychiatry. But they also included moving personal essays that were published in newspapers; The Economist (yes, The Economist) covered mental illness and the burden of disease well and thoughtfully; the best articles on global psychiatry appeared in The New York Times.

It wasn’t that long ago that we hoped that discussion of mental illness would move out of the shadows. Today, slowly but surely, it is. And so, 2015 closes after 48 Readings and on this hopeful note.

DG Continue reading

Reading of the Week: Physician, Heal Thyself: Residents and Depression, and More

From the Editor

This week – like last week – we pick a few interesting readings to consider.

This week’s selections: a chef and his addiction, a major new JAMA paper on resident physicians and depressive symptoms, and a big paper from BMJ comparing CBT and meds for depression.

Next week: the best of the year (the annual tradition). Suggestions are welcome for the best papers of 2015.

DG

Selection 1

“Three years after his mysterious disappearance, former Langdon Hall chef breaks his silence”

Mark Schatzker, The Globe and Mail, 1 December 2015

On the night of Dec. 28, 2012, Jonathan Gushue, one of Canada’s most decorated chefs, disappeared. He finished a dinner service at Langdon Hall that included pickerel in crème fraîche with black radish and black-pepper honey, got into his car and never arrived home.

No one, including Gushue’s wife, his sous chefs and his friends, knew what had happened to the 41-year-old father of three who, just two years earlier, had put Langdon Hall, in Cambridge, Ont., on the prestigious San Pellegrino World’s Best Restaurants list. As the chef’s disappearance made headlines from coast to coast, mysterious details began leaking out – his phone was found at an upscale Toronto hotel – but nothing more.

Thirteen days later, Gushue was found and reported safe. Several months later, he left Langdon Hall, then vanished from public life.

Jonathan Gushue

Gushue had it all – a young family and a soaring career. He also had alcoholism. Continue reading

Reading of the Week: A Father Mourns His Son, and More

Note from the Editor

In most Readings of the Week, a paper or essay is selected and then discussed in the commentary.

This week, we try something a bit different: a few pieces are selected and briefly discussed. We can cover more ground this way, and consider some pieces that may not have warranted a “full” Reading, but are still worthy of consideration.

DG

 

Selection 1: “How to Help Save the Mentally Ill From Themselves”

Norman J. Ornstein, The New York Times, 17 November 2015

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My older son, Matthew Ornstein, died at age 34 on Jan. 3 from carbon monoxide poisoning. It was accidental — he fell asleep in a tent with a propane lantern — but his death was shaped by a lack of judgment driven by a 10-year struggle with mental illness.

Continue reading

My Globe essay: “Mr. Trudeau: Canada’s mentally ill need a new approach to care” – co-written with Dr. David Goldbloom

With a new government in Ottawa, Dr. David Goldbloom of CAMH and I consider what could be done to help those with mental illness.

Here’s the link for our Globe essay:

http://www.theglobeandmail.com/globe-debate/a-new-approach-to-helping-canadas-mentally-ill/article27629866/

National Post essay: Our next great national project: let’s end homelessness

In today’s National Post, I have an op ed on homelessness and Housing First in light of our national effort to take in and house 25,000 refugees.

Here’s the link:

http://news.nationalpost.com/full-comment/david-gratzer-our-next-great-national-project-lets-end-homelessness

The article follows. Continue reading

Reading of the Week: Let There Be Light

Major depressive disorder (MDD) affects at least 5% of the population, with a lifetime prevalence estimated at 14%. It is the second-ranked cause of disability worldwide and is associated with impairment in quality of life, increased risk of mortality, and societal burden. Treatments for MDD include psychotherapies and antidepressants, but remission rates remain low despite adequate treatment and more therapeutic options are needed.

Light therapy, an effective treatment for seasonal affective disorder (SAD), may also be appropriate for MDD. Bright light is a safe, well-tolerated, nonpharmacological treatment that can be used alone or combined with medications. Light can correct disturbed circadian rhythms, which have been implicated in the pathophysiology of MDD. Previous metaanalyses of light therapy for nonseasonal MDD, however, have yielded only equivocal and conflicting evidence for efficacy. Two more recent systematic reviews both concluded that the quality and methods of the identified studies were too heterogeneous to conduct a meta-analysis. They each found insufficient evidence for efficacy of bright light monotherapy, although 1 review found low-quality evidence for bright light as adjuvant treatment to antidepressants.

In summary, these systematic reviews indicate that the evidence for benefits of bright light therapy for nonseasonal MDD is inconclusive and well-designed studies are required to resolve this issue.

So begins a new paper on depression. I like these opening paragraphs and, in particular, the first paragraph (and its bluntness). For the clinicians among us, the final phrase is hauntingly true: “more therapeutic options are needed.”

This week’s Reading: “Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial” by Dr. Raymond W. Lam et al., which was just published online (ahead of print) in JAMA Psychiatry.

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This is a big paper in a big journal with big clinical implications. It’s also very Canadian – every co-author lives north of the 49th parallel; the first author hails from Vancouver.

We know that light therapy works for those with a seasonal pattern to their depression. But could we use the light therapy for other people suffering from depression? The authors attempt to answer this question. Continue reading